Plumbers and Electricians

Thanks for all the emails that keep arriving, it's brilliant to see that someone reads this. Do leave me a comment if you visit - makes my day every time!

The main thing I keep getting asked is :

1. What made me want to change from nursing to medicine
2. Has my nursing background helped since moving to medicine

I will answer the first question soon, but have to say that as far as the second question goes, my nursing background has not helped me in the slightest.

In my humble opinion, nursing and medicine have little in common. I never thought this to start with - I presumed that I would be half way to being a doctor with my nursing degree and twelve years experience but this just is not the case.

I was a 1992 "Project 2000" nursing student, a course which was criticised for being too academic and not clinical enough. For the first 18 months we were classroom based, studying sociology, psychology and physiology.

For the first 18 months in medical school, we studied biochemistry, genetics, histology, epidemiology, cell biology, pharmacology (None of this was covered in any fashion as a student nurse) and clinical modules such as MSK, CVS, nephrology, GI etc. We spent 12 weeks on each module, starting with the biochemistry of each clinical subject and working up to pathological processes.

After three years I have realised that thinking that nursing was going to give me a leg up the medical ladder was very, very wrong.

Nurses and Doctors are like plumbers and electricians. They both work in the same environment and are specialised in what they do. They cannot do each others jobs, simply because the jobs are different. By them doing their different jobs and sticking to what they know best, the house gets built.

If the plumber is off sick, the electrician can't cover their job. I don't think doctors could cover the nurses job any better than a nurse could cover a doctor's.

To wander off the trail a little, I think one problem is that although the jobs are completely different, there are tasks within each role that cross over (Bloods, interpreting spirometry, cannulation etc) Over my twelve years in nursing, I saw the boundaries between nursing and medicine blur, as the managers realised that nurses were not only cheaper, but could so some of the doctors tasks (I have trundled on about this here)

In my old job in occupational health, this quickly lead to a reduction in the docs hours as managers assessed which parts of their roles could be sliced off and handed to the nurses. Then, lo and behold, the same managers realised that "Technicians" were cheaper than nurses. Hey great - lets shave the nurses role (Presumably so that she could do some of the docs job) and pay the technicians half of what the nurse earns. Don't think I am exaggerating here, over a period of five years, the doctor's hours reduced from 5 a week to 4 a month and when one of the OH nurses left, she was replaced with a fork lift truck driver who had taken a OH technicians course at Carmarthen college)

To get back to the original subject, I will be interested to see if my view changes in my last 18 months as a medical student, but so far nursing just hasn't helped me as a medical student.

Has anything changed since 1954?

With big exams looming, I am procrastinating like a good'un. I managed to watch "Doctor in the House" again today. Some of the acting is a bit duff (The "Welsh" chap sounds like he is from Glasgow) but lots of things seem exactly the same.




This is my favourite clip - still happens in most hospitals up and down the country, every day!

Star Trek

I went to theatre a few days ago to see an Atrial Fibrillation ablation. Hells bells - it was amazing, like something off tomorrow's world.

Ablations are done when drugs and cardioversion have failed to convert the heart back to sinus rhythm. It's a long procedure, done under local (This continues to shock me - imagine lying fully awake for five hours whilst someone burns your heart) and the patient tolerated it really well. They start by pushing tubes up through each femoral vein and then they push a round ended tip into the right atrium. Things get a bit scary (For me anyway - everyone else seemed quite blase!) at this point because they have to then push the tip of the catheter through the wall of the atria, through what would have been the foramen ovale when the patient was in the womb. Creating a hole in the heart seemed worrying to me, but apparently it heals and is fine.

It got really exciting then - they push another catheter into the heart and start to build a 3D image of the patients heart. It's hard to explain, but every time the catheter tip touches the atria, the software recognises it and maps like a geometrical image. It was unbelievable - it takes about an hour and then they have a model that looks a bit like the one at the top of this page, only much clearer. Once this is done, they start the ablation which basically means making lots of small burns on the atria with the aim of interfering with the electrical signals and hopefully prompt the heart to flip into sinus rhythm.

I went to speak to the patient the next day to see what he had thought of it all - he was bright as a button and only remembered small bits of what had happened (A little bit of midalozam seemed to have helped)

Then, today I got a bit upset in clinic. I think of myself as quite a tough nut as far as people go - I am useless with animals but I tend to be fine with people and not much upsets me.

An old chap came in with his daughter. His heart had been going a bit slowly and so it was recommended that he had a pacemaker. Unfortunately he was deaf and did not speak much English. He had also lost his wife a few months ago and was understandably very down. As he left the room, after not speaking all through the consultation, he came up to me and and said that it is important to love one person for all of your life and that when you have loved someone all your life and then they die, you want to die and go with them. Sounds a bit naff when I am writing it, but it made me fill up. Crying in front of the consultant is not a good look!

I'm not having anything done under local anaesthetic!

Hello.!

I have finished my month in respiratory medicine and now am stuck in cardio for three weeks. I think it's a bit crap that this three weeks is all I have in cardiology for the whole of my clinical training. Seems like too little experience for such common illness. This is made worse by one of my consultants wanting me to attend a pacing clinic three times a week. I went this week and watched a patient have an implantable defib fitted under local (more about that later) than I watched another patient having an implantable defib fitted. Then I watched another patient having an implantable device....OK you get the picture.

I'm a bit annoyed at having to stand in theatre three times this week watching patient after patient having the same thing done. I learn very little from this - watching one so that I am aware of what happens is great, but having to watch it again and again isn't. I feel like my time would be so much better spend on the wards, trying to work out how to look after barn door heart failure, arrhythmias etc. It's hard though because if I dig my heels in and go to the wards rather than theatre, I might well end up in a situation where the consultant refuses to sign my end of module forms (Details of attendance, performance etc)

What has also scared me is that having one of these devices fitted is a bit nasty. They take around 2 hours and the patient has it all done under a local anaesthetic. They lie there and seem to be in agony when the local is being given. Things get better then apart from one patient who seemed to feel the whole thing and was squirming throughout. I was starting to feel a bit light headed to be honest - it's not nice watching someone in pain during an operation.

It seems that the risks of G.A make it much safer to do this under local. Also, they are not often able to give the patient midazolam (Sedative) because it makes the blood pressure drop which they tell me isn't good in the middle of heart procedures.

I hope I never have to have anything done under a local - on my last block an old chap was having his carpel tunnel done under an axillary block and told the surgeon he could feel her cutting his hand. Hells bells.

Fed up

Every weekend, I go back home to Wales 150 miles away to see the family and my dogs. Friday night is brilliant - get home at 8 and watch crap TV with the dogs on my knee. Get up and go to work all day Saturday to earn some money to keep the lights on. Have a nice meal on Sat night. Nice, normal stuff.

Sundays are horrid; by now we are getting used to being back home with the family and nice surroundings. We remember how nice and easy our old life used to be, before leaving local well paid jobs for me to study medicine. I take the dogs back to my mums, and then pack the car up before hitting the motorway to come back here.

I am sitting back in my little flat now - am very depressed! Would rather be back home with my three smelly dogs on my knee, reading the Sunday papers with my mum. These are the hard parts of giving everything up to do medicine when you are an oldie.

Never mind...tomorrow I will be one step closer to qualifying and then we can get our lives back to some normality.

Bloody GPs

I see that the old boot Carole Malone is having another pop at GPs again in the (Scroll down to third story) NOTW

This women is vile - her view is that GPs are now earning too much money for doing too little work. This other story in June is just as hateful.

I have followed her rantings for some time and can empathize a teeny teeny little bit. Her father apparently was very ill and got seen by an OOT locum who did not know his details. She feels that his care suffered greatly because of this. I can understand being distressed if you feel that a parent was not receiving optimal care...I have been in the same boat and it's horrid.

But this women has gone on a one women mission to attack GP pay, hours and reason for being: she is nothing short of spiteful and venomous in her writings. As far as she is concerned, medicine should be vocational and GPs should still be working day and night to ensure that their patients are always seen by their family GP. Oh yes....let me add that as well as GPs working day and night, they should go back to earning what they were five years ago. i.e. a hell of a lot less than now.

I wander how big a part vocation actually plays in people's decisions to study medicine? I don't think that there is any doubt that we all do this because we want to help people - I think the job would be un-doable without a personal need to try to help. But...and I know this will be controversial......If one has a vocation to help people, how do they choose between being a doctor or being a nurse? Nurses help people all day every day, work their arses off and earn around £25000. Doctors help people too and have potential to earn a lot more.

At my interview for medical school, I was asked why I wanted to move from nursing to medicine. This was hard! The old chestnut "I want to help people" wouldn't wash, because you can do this as a nurse. I gave a right old bunkum answer about wanting to help people at a "Higher level" (LOL!) The interviewer said to me "OK so you want to help people, but earn more money whilst doing it"

How can I argue with this?! Medicine for me is about providing excellent care but also about fulfilling my potential and earning a better wage than I could as a nurse. Admitting that good pay is one of the attractions of going into medicine remains a taboo area and not something I ever hear people talk about.

Another interesting point is that I know many nurses who are moving into medicine. I have NEVER heard of a doctor moving into nursing. I think this says it all!

When is it OK to hurt a patient?

As mentioned, I am LOVING this orthopaedics block! My consultant has a reputation of being a scary screamer but so far she has been brilliant with me and my clinical partner and so life is good.

What is good about this placement is that my consultant is a shoulder specialist which means that most people who come to see her have impingement, instability, a-c pain, humerus fracture or a frozen shoulder. This might not seem very exciting but it has meant that we have become good at diagnosing and managing these complaints. On my GP block, every bloody patient that came had something different...you got your head around working out what the chest pain was due to and then they left and a new patient came in with a toe problem.....I liken the experience to swimming backwards in poo.

Anyway - in clinic this week, a 50 year old lady attended with severe shoulder pain. Her passive arm flexion and abduction was 60 degrees, after which active movement was possible but with horrid pain. We were asked to take a history from her, examine her, make a diagnosis and then present the case to the consultant, who would then come and examine her again and discuss treatment options.

I took her history and then started to examine her. After looking at her cervical spine movement, I began the arm movements, managing to get her flexion to 180 degrees, albeit with clear pain. In fact, the pain was so bad that she started crying and she wasn't a wimpy lady - it was just clear that she was in agony. I decided at that point not to continue to abduct her arm because the other tests indicated that she had supraspinatus impingement which was likely to produce a painful arc. So I left the abduction and did some of the other examination which she managed, without reproducing too much of her pain.

When we left the room to go and find the consultant, my clinical partner voiced his concern with what I had just done. He felt that I should have continued with the full exam, despite the fact she was crying with pain. He felt that by not persisting, I had failed in my examination. I told him that I felt that continuing to examine her, despite pain and tears would actually be unethical. This didn't go down terribly well with him but I stood my ground because although I might not be a font of medical knowledge, my nursing background has given me a lot of insight into patient care.

Since my first contact with patients as a medical student, I have been very aware of the fact that when we examine patients, it is usually for OUR benefit, not for the patient's. We know so little that examining is how we learn, but in this case I knew that continuing with the exam was causing her significant pain and that once I had presented the case to my consultant, she would then have to go all through it again.

My clinical partner was not amused that I stood my ground on this one and I think the reason for this might be our backgrounds. He is an ex-physiotherapist and I think it's fair to say that physio's often cause pain, albeit for the good of the patient's recovery!

So was I wrong?

Back in action!

OMG - can't believe that it's October and two months have passed since my last post.

To bring things up to date.....I HATED GP placement because my GP was a bullying prat. After GP block, I had a three week "Elective" We had to choose between pathology, Haematology, Radiology or Humanities.(Pathology was my first choice - I fancied working with nice, quiet, dead people after seeing so many live, moaning, ones during my GP block)

Fortunately, or unfortunately (I'm still not sure) I got allotted to my last choice which was humanities. What an experience! Apparently there is a national movement towards trying to introduce humanities into medicine. By that, I mean poetry, opera, photography...all the arty subjects which I was crap at in school. There was no "Humanities" per se in the 1980's - I am told that this is now a GCSE subject.

Anyway...on the intro morning the chap running the course tried to explain what the humanities elective was trying to achieve i.e. broaden medical student's thinking by looking at areas we never normally would. We spent two hours discussing the word "Humanities" I think I give up the will to live after 20 mins.

The short of it is that we each had to produce a 15 minute presentation on subjects like "Was Hamlet mentally ill?"

I'm a bit rough around the edges and not usually into opera, radio plays or literature but I enjoyed the presentations and am not sorry I ended up on the elective after all! I have even found an arty medical picture for you (See above!)

After this, we had a month's holiday. I am being credit crunched to within an inch of my life so couldn't afford a holiday but had a lovely month doing nothing and watching Jeremy Kyle every morning.

Then, three weeks ago I started on my orthopaedics block and am LOVING it! Hells bells, that's the first time since I started Medicine in 2006 that I have said those words. So far the course has been anything except enjoyable - it's just one long slog really, with little bits of hope thrown in every now and then.

Thank God that's over with!

WHOHOOOOOOO!!!!

Have finished my GP block and am SO happy! I have massive respect for GP's after this placement as I never before realised that they have such a tough job. At least on a ward, you get to be part of a team and can order tests and scans to help. I reckon that if you were less than confident in your own ability as a doctor, being a GP would be impossible. Most of the time, the patients coming to see you have common conditions such as UTIs and chest infections, but every now and then it seems that one of them actually has something serious and the skill seems to be picking these up.

I have watched public opinion turn against GPs this year and the rants in the press by the likes of Carole Malone make me sick. I have no doubt that this backlash wouldn't have happened if GP's were not found out to be earning such good money. It really, really annoys me to see that so many people begrudge GPs earning decent money.

Anyway - that placement is over so I now have three weeks on an "Elective" and then four weeks holiday. WOOP WOOP!!

How things can change

Oh shite - how things have changed since my last entry, when GP land all seemed so good. I didn't know if I would write about this but I am going to because it has had such a profound effect on me.

On the first week of this placement, I was timetabled to do a clinic with a GP whom I hadn't met. Before I went in, a few of the receptionists commented that the GP was a bit of an odd one but I thought nothing of it and went in like a lamb to the slaughter. My first impressions of him: "Who is this knob"

This guy ripped me to shreds in front of every patient. Nothing I said was right - he even picked me up on how I pronounced "gastrocnemius" (Apparently I did not say the "c" succinctly enough) He also told me off for wearing gloves to test a urine sample (WTF???!!)("Why are you wearing gloves - you could drink that urine")

Even after one clinic with him, my self confidence was battered - I stayed on a downer all night. The next day, I was back in medical school for training, and a different GP and my fellow students watched a video of one of my consultations. The GP made me stop my video three times, asking who this GP was and why he kept interupting me. I later had a call from the medical school to say that they were concerned with what they had seen and did I want to do anything about it.

Now it is worth me reminding you that I am no spring chicken - I am actually the same age as this GP. I am not a complainer because I feel that in medical school, complainers get labelled as problem children. I decided not to do anything about him but to give it time and see if things settled (I am starting to sound like a proper GP)

I also felt that the knob had a point - I did not know as much as I should have.

So over the next three weeks, I continued to turn up and his behaviour towards me became progressively worse. The culmination was this week, when I sat on the sofa and decided that I was not clever enough to do medicine. I was pretty much at rock bottom and realised that this chap had managed to bring me so low that I had lost every shred of my confidence.

So I finally did something - I told the practice that I couldn't do any more clinics with him. I now feel like the problem child that I knew I would feel like but the thought of sitting in his clinics is so horrific that I will put up with it.

It amazes me that knobs like this can have profound effects on us when we are adults. I would have thought that as you get older, your ability to cope with these characters gets better and I would not have thought that at my age, working with this bloke could have been so detrimental to me. I also realise that although my medical knowledge is...shall we say sparse in many areas, this is actually OK because I am only a 2nd year medical student!

The conclusion of this is that I have hated this placement. The other GP's have been brilliant with me, but I have a bad taste in my mouth because I feel that they all know what he is like and decided to put me with him anyway.

PS. As from yesterday, I am no longer a rectal exam virgin. EEWWWWWWWWWWWWW!

Morning tea breaks, 2 hour lunch breaks, afternoon tea breaks - I have woke up and gone to heaven

I have now finished my seven week placement in general medicine and have this week, moved to general practice for seven weeks.

My first impressions are that, bloody hell this is a civilised profession - they have start times and finish times and tea breaks, where nice ladies on reception bring them tea (In china cup and saucer - result) They earn loadsamoney and only have to do a little bit of OOH cover. It seems to be the antithesis of hospital medicine and these doctors actually seem to have a life.

It is interesting then, that when I got together with my group today lots of them are hating their GP placement and can't wait to get back to acute care. They felt that most patients rolling through the door didn't need to come to see their GP (Minor skin rashes and ailments that are already getting better when they attend) They also felt that after a morning of seeing children with Hayfever, they wanted to climb out of the window and run to the hills (Or the nearest hospital)

Me, on the other hand LOVES it!! Well I would if I wasn't so terrified - I am absolutely bloody cacking it. I got so stressed on Tuesday that I had to nip outside to try to breath. The problem you see, is that on the wards, we are in groups of six / seven medical students and so when questions are asked, one of us can usually pipe up. In GP land however it is just me and the GP. There is nowhere to hide and it is butt clenchingly terrifying.

For example, a nice lady Mrs A brought her two children in this week. She had recognised that both of them had hayfever and she wanted a prescription for piriton so that she could leave and return her children to school. Instead, what she got was Anna the pale, shaking, medical student. This was the first visit that the GP told me to handle from beginning to end and hell, did I make a meal of it. She got asked about her kids' bladder and bowels (Commonly affected in hayfever....not) and about other "pertinent" points such as "Have they been abroad lately"

I made a mess - a real hellish mess. I know that if I had not had the GP sitting in the corner I would have been absolutely fine. I could easily have handled this, prescribed and sent them off to school. Instead, I went to pieces and I can just picture the mum pissing herself laughing to her mates about what this freak from Wales had been waffling on about.

I think that if I could find a way of developing my confidence, I would be half way there. I have spent my time at medical school feeling like an impostor and even now don't feel like a real medical student. I need to get me some ego!

Breaks are for wimps

Having been in clinical medicine for a grand total of 14 weeks, I would say that Medicine is a very macho profession:

• Doctors don't take breaks....ever. We start ward round at 9am and it finishes around 1300. Four hours standing to attention with no 5 mins put aside for a quick drink. When the ward round finishes, clinic starts and so there is no room for lunch either. At 1700, teaching starts and that will carry on until the consultant gets bleeped away (Or until he finally realises that he has a wife and baby who expected him home three hours ago)

I don't know any other profession that expects it's colleagues to function like this. Every factory and ward I have ever worked on honours basic tea and meal breaks. As a nurse - the wards were manic but a part of the senior nurses role was to make sure that the nurses got their breaks. Medicine seems to be about seeing how long you can stay on your feet before falling over. If you succumb and fall over - that is a sign of weakness. If I was not in medicine, I would assume that they don't take breaks because they are too busy, but on my ward this is simply not true. They don't take breaks because that is not what doctors do.

• Medical students get brain washed into thinking that this is normal very, very quickly. I suppose most of them have never worked before and so perhaps presume that this is how every one works.
  
• Surgeons are even worse - as a student it's generally best to avoid the OT at all costs. On the day I was daft enough to wander in, I found myself holding a retractor for a six hour stretch. I was too scared to ask to go for a wee because the surgeon commented in the first half hour "I hope you're made of sturdier stuff than the anorexic waif we had in here yesterday. She passed out after a few hours and then said it was because we made her stand up for too long

Bums

I have never been unfortunate enough to need to have a doctor put his finger up my bum. I hope I never need to, but the thought of me having to do that to someone else isn't much better.

I nearly had to do my first rectal exam today - I managed to go the loo at an excellent time and so my clinical partner was landed with it. He was told to "Go and do a rectal" on an constipated alcoholic patient. The SHO told him that it had to be done "To see if there is poo in his rectum"

WTF???? Of course there is going to be poo in there! If he hasn't poo-ed for four days, where is it going to be, other than in his rectum?

I kind of hovered around the bed whilst my clinical partner got his gloves ready. The SHO told him what to do and so, after covering himself and the bed in KY jelly, he did the deed. Although we had the curtains around the patient, The SHO managed to shout really loudly "Put your finger in and tell me if there is hard faeces there" The other patients sniggered and the visitors around the next bed went very quiet.

My clinical partner didn't say much for the rest of the day and struggled to eat his free curry (Drug reps are wonderful people!)

It's hard to think that these things will soon become as routine as taking blood - just part of the everyday routine. The funny thing is that if I was training to be a vet, I don't think that I would have any worries about sticking my finger up a dogs' bum. It just seems a dreadful thing to have to do to a man. I wander too, how necessary some of the rectal exams are. I can understand their need to assess prostate size and prescence of malignany, but I am not too convinced about doing them for constipation, like the one today. I asked the SHO why this was needed for constipated patients and he really couldn't answer me, only to say that "This is how we assess the level of constipation"

Oh well - I expect this time next week, I will no longer be a rectal exam virgin!

When will the penny drop??.......

I really don't understand people. The older that I get, the less I understand people.

Take Mr A. He is a 57 year old male who came into hospital a week ago after experiencing numbness down his right side whilst working in the garden. I first saw him two days after his admission on the ward round. His numbness had subsided but not completely gone away and so he was advised that he had suffered a stroke (If his symptoms had completely gone away within 24 hours it would have been a TIA)

The consultant sat down with him and went through his risk factors for stroke. He had smoked 20-30 a day since the age of 20. His cholesterol was reasonable at 5.4 mmols / l and his blood pressure a little raised at 140/92. His father had died from an MI aged 62.

The consultant explained to him that he had had a mild stroke and was at quite high risk of having another one in the next month. He told him that now was a good time to give up smoking and explained how this mild stroke was a warning sign which needed to be heeded. The consultant also said that he was worried that Mr A might have furred up carotid arteries and arranged for a scan to assess the level of furring.

Mr A was clearly terrified and I really felt for him. I visited him after the consultant had left and we chatted about what had been spoken about. His main fear was about his neck arteries being clogged up because he was scared of the treatment that might be needed. We agreed that it was good that this stroke was a mild one, because he was not going to be left with any impairment and so it could be taken as a warning sign.

Next day and Mr A went off for his scan. It was good news.....his carotid arteries were not furred up and so no treatment was needed. Mr A was a happy bunny. So happy, in fact that he took himself straight off to the car park and.....yes, you guessed it, got his fag packet out and started to smoke.

My colleagues and I sat in the canteen and watched him smoking. We were pretty dumbstruck to be honest. When does the penny drop? When do you throw your arms in the air and say "You know what, I have smoked for 37 years and I have just had a stroke that I have completely recovered from. I am a lucky bastard because I have had a warning sign that things need to change"

Instead Mr A's arm in the air moment was "I am a lucky bastard. I have smoked for 37 years and don't have any furred up arteries. I haven't done myself any damage......bring on the fags"

People are funny buggers.

Men I would leave my husband for (Part two)

Christian Ronaldo is the newest addition to my list.

My husband and I both have a list of people who we would leave the other for. This might shock people but bearing in mind that my list is Ronaldo, Patrick Dempsey and Jay-Z and my husbands list is Pamela Armstrong and Carmen Electra (He wanted to add Gemmma Atkinson to his list but I dug my heels in) I don't think any of us are going to be packing our bags any time soon!

Being thrown to the Lions

Hmmmmm. Medicine is very different to nursing. I never expected to say this, but the doctors could learn a hell of a lot from nurses on how to train someone to do a job.

Example 1. By Thursday I think the three of us (My clinical partner, German playmate and me) were the ward sport (We imagined them taking bets in the sluice of how quick they could make us crumble)

Halfway through the morning, one of the SHOs told us to "Sort the bloods out" Wanting to look eager, and terrified of upsetting them anymore than we had already done, I said "But we have never taken any bloods"

"Then this is the ideal time to learn then, isn't it" She snarled back. Oh shit - I did a venepuncture course two years ago (It was during the lunch time of this course that I found out that my dad had been admitted with his stroke - See early posts) but have never practised it. Our German mate had also trained in it but used a German blood taking system and so wasn't really up to the job either)

I asked the SHO if she would mind doing the first one so that we knew which colour bottles to use and so that we could work out really small matters like where you stuck the needle in. She told us to "Work it out" so off we shuffled to form a battle plan. Luckily, the ward clerk saw us looking terrified and came to show us which colour bottles to use. We made an executive decision that our German mate could do the deed and followed him on to the ward. He actually managed to take the blood reasonably well from the patient and so off we shuffled, triumphant!

I hate reflecting but I would have to say that I am HORRIFIED at my actions. I should have dug my heels in and told the SHO to go and take a running jump. How STUPID was she though - surely it it dreadful practice to expect us to do something we haven't been trained to do, without at least showing us the correct way of doing it.

This would never happened as a nurse. When I qualified, you had to do 6 months on a ward before being allowed to attend a venepuncture course. You then had to be supervised in taking blood off five patients before being signed of as fit to practice.

I need to work out what I am going to say the next time this happens because from what I can see so far, being a medical student is like being thrown to the lions on a daily basis and if I don't learn how to speak up now, I am going to get eaten up.

The bubble has burst

So, I finished my pscyhiatry placement and am now in General medicine for seven weeks. It is the end of my first week now and I have had my bubble well and truly burst.

We arrived on the EMU (Emergency Medical Unit) which is a bit like casualty but with medical patients) on Wednesday afternoon and it was like walking into a circus. No-one asked us who we were or what year we were in, they just saw that we had pink student badges around our necks and told us to "Go and clerk that patient on trolley 3"

Now then, my clinical partner is an ex physio and we also have a playmate with us on this placement from Germany. He is a final year medical student who for some obscure reason, decided to come to the East Midlands on his elective (Poor Sod was obviously told that it was a lovely part of the world)

So the three of us (Who have never clerked a patient in or seen anyone else do it) shuffled to the trolley as directed. On the trolley was a 35 year old women with a left hemiparesis who had been brought in fours hours earlier by her husband (He had a nice suit on and we were terrified that he was a consultant)The look of relief on their faces when they saw us was massive (Oh God, if only they knew) so I sat down and went through my patient history headings (Listed below for anyone who might want to know these things)

Presening complaint
History of presenting complaint
Past medical history
Drug history
Social history
Family history

Our German friend was then pushed forward to do the physical bit. He decided to do a neuro exam and proceeded to test her cranial nerves, motor tone and power. We then shuffled back off, leaving her oblivious to the fact that we didn't have a clue what was wrong with her and that she would have to go through it all again when the FY1 was available.

What a joke - is this how they think they are going to train us? What the hell happened to "See one, do one, teach one"?

I never realised that I was mentally ill.

I am now on my first clinical placement on junior rotation, in psychiatry. My only other experience in mental health was in 1993 as a student nurse, when I was placed in a "drop in" day centre (Couldn't believe how many fags a group of people could get through). I think it is fair to say that until this week, my views of mental illness were archaic - mental illness happened to strange people who then went on to do very strange things.

I started this week by sitting in on an outpatient clinic with my psychiatrist. Most of the visiting patients were in various stages of depression and I made the mistake of commenting that I had never thought of depressed people as being mentally ill. I was depressed after my dad had his stroke a few years ago and ended up on six weeks of Citalopram. I knew I was depressed, but never for one moment thought of myself as being mentally ill!

I have always thought of mentally ill people as psychotic nutters (I had an altercation with a paranoid schizophrenic once that is probably to blame) but what I have learnt immediately, is that mental illness happens to normal people. It seems that you can be perfectly well one day and then wake up the next hearing voices and seeing little men running around the room. The latter are called "Lilliputian hallucinations" I love that name!

I also never knew that ECT was still a treatment and never knew that giving an anti-psychotic drug can stop the voices in Schizophrenia. That amazes me - how can a drug stop voices in your head? Apparently the voices start when too much dopamine flies around your brain, so drugs are given which bind dopamine receptors and when most of the receptors are bound, the voices stop. Brilliant.

My consultant has given me a DVD of "One flew over the cuckoo's nest" to watch this weekend. It looks a bit depressing but I think I had better keep in his good books after the "Depressed people aren't mentally ill" comment

Not many people fail in medical school

Hello!

Hells bells - can't believe it has been a year. Thank you very much to those of you who have emailed me to ask how I am getting on.


Well - to bring you up to date - I am now half way though my second year which is unbelievable. I have (Just this week) started my clinical training in my first junior rotation in psychiatry. It has been an absolute slog to get here and I think that this is why I stopped writing these posts. The other reason was that I didn't pass everything that I needed to pass and so ended up in what my medical school calls "A qualifier"

On my first day at medical school, the Dean told the audience of 400 or so students, that in four or five years time, 95% of us would be doctors. The reality is that in medical school, most people pass all the exams that are thrown at them. If you, like me, are in the small group that does not pass everything - it is not pleasant.

In February, the students on the five year course did their pre clinical exams. Out of 372 students, 82 failed one or more exams and ended up in the qualifier. In my cohort of graduate entry, 50 sat the pre-clinicals and twelve of us ended up in the qualifier.

Being in the qualifier means that you have to do the whole lot of exams again - even the stuff that you passed. Personally, I passed the clinical exam and one of the written papers, but failed the second written paper. I then had three weeks to study my arse off before sitting the whole lot two weeks ago. Thank God - I passed, and so was allowed to progress to my clinical training. Eight of my fellow qualifieees have not been so lucky and are now off the course.

Having been at this now for eighteen months I have formed some strong opinions on doing medicine as a mature candidate. From what i can see, if anything goes wrong in your life whilst studying medicine, the odds for failing rocket. I think that this is the case for any subject but graduate entry medicine does not allow any buffer for illness, turmoil or wanting to have a life. As you probably know, graduate entrants do the preclinical training in eighteen months instead of 2.5 years. Despite what you may have heard, we do exactly the same modules as the five year lot, (Well apart from a bit of Head and Neck studies, but what's a mandible between friends) so over the three semesters our workload is 33% greater than the five years students.

Some of you might be reading this, thinking that people who fail and end up in the qualifier are there because they haven't worked hard. This is BS - we worked hard, but just not hard enough!
Anyway - enough about qualifiers and stuff - I passed the shitty thing so I made it!! I have no more exams until February 2009. Whohoooooooooooo!!!!!!!